Dissertations / Theses on the topic 'Medical Sociology'

Stadig mer forskning fokuserer på utviklingen og bruken av teknologi, ikke minst i forbindelse med den stadige mer utbredte bruken av informasjons- og kommunikasjonsteknologi. Mange av disse studiene har vært motivert av ønsket om å vise til de fantastiske mulighetene som organisasjoner (særlig bedrifter) har ved å nyttiggjøre seg nyvinningene (se f.eks. Davidow og Malone, 1992 og Scott Morton, 1991). Mange samfunnsvitenskapelige studier har imidlertid inntatt en mye mer kritisk holdning til de teknologiske nyvinningene. Innenfor sosiologien er det flere slike tilnærminger.

Sosiologiske perspektiver på teknologi

I de funksjonalistiske tilnærmingene fokuseres det på hvilke effekter de tekniske systemene har på brukerne av dem, og spesielt hvordan alle systemer medfører uintenderte konsekvenser, blant annet ved at de nye systemenes latente funksjoner (Merton, 1967) trer fram i dagen etterhvert som systemene kommer i bruk. I disse studiene betrakter man de tekniske systemene som makrostrukturer som følger sin egen utvikling mer eller mindre uavhengig av brukerne (dvs de er teknologideterministiske).

I Marxistiske tilnærminger unngår man en ensidig determinisme ved at teknologiene antas å være i dialektisk motsetning til de sosiale systemene. Spesielt betraktes teknologiske nyvinninger som kapitalistenes middel for å beholde sitt herredømme over arbeiderklassen. I nyere perspektiver (se f.eks. Winner, 1977; 1986, Hirschorn, 1984; Feenberg, 1991) påpeker man at det er de kulturelle verdiene som er knyttet til teknologidesign som medfører uheldige konsekvenser (som for eksempel degradering av arbeidskraft), og ikke teknologien i seg selv.

Tilsvarende fokuserer de sosialkonstruktivistiske studiene (Bijker, Hughes og Pinch, 1987; Bijker og Law, 1992; Law, 1991) på hvordan den teknologiske utviklingen eller de teknologiske nnovasjonene ikke følger naturlige utviklingsveier, men konstrueres i nettverk av aktører som hver på sin måte presser fram sine interesser i forhold til et teknologisk artefakt. Mange av konstruktivistene benekter et skille mellom tekniske og sosiale systemer (eller aktører). De mener at det er umulig å egentlig separere det tekniske og sosiale, og velger i stedet å betrakte de totale relasjonene som et sømløst vev. Konstruktivistene bruker spesielt historiske studier av teknologi-utvikling for å identifisere aktører i slike vev, og dermed undersøke hva som ligger bak de løsninger som velges i utviklingen av tekniske artefakter.

I de senere årene er det blitt flere forskere som ved å bruke etnografiske studier av teknologisk praksis undersøker hvordan tekniske og sosiale aktører samhandler. I disse studiene er man i motsetning til de konstruktivistiske tilnærmingene mer opptatt av bruken av teknologi enn utviklingen av den. Men i samme ånd som konstruktivistene er man opptatt av å vise hvordan den teknologiske praksis i sterk grad utvikles ved hjelp av sosiale mekanismer, for eksempel i arbeidsgrupper, og hvordan tekniske praksisimperativer rekonstrueres i daglig sosial praksis (se f.eks. Suchman, 1987; Hutchins, 1988; 1990; 1995; Hutchins og Klausen, 1996; Heath og Luff, 1992; 1996; Orr, 1996; Engeström og Middleton, 1996).

Alle disse tilnærmingene har viktige bidrag til sosiologiske studier av utvikling og bruk av teknologi. Imidlertid ser det ut til at det er vanskelig å skape en teoretisk syntese av teorier som bygger på såpass forskjellige antakelser. I denne avhandlingen kombinerer jeg imidlertid deler fra teoriene ved et feltstudium der én type teknologi benyttes i flere ulike kontekster, slik at både aktør-perspektiver og struktur-perspektiver blir relevante. Et empirisk felt som gir denne muligheten er bruken av medisinske nødmeldesentraler i Norge.

The study of technology has recently become more focused in various schools of sociology. However, Marxist, functionalist, social constructivist, and ethnographic research, have tended to explain technological development either from macro or micro perspectives. Further research is needed to increase our understanding of technology as situated in its social and institutional contexts, where individual and professional relations are considered. In this thesis, elements from several approaches are applied to the study of communication technology in Norwegian medical emergency communication centres.

About ten years ago, LV (doctor-on-call) centres, each manned by one nurse to handle local requests for a doctor, were established in nursing homes. AMK (acute medical communication) centres were introduced in hospitals, and are manned by teams of two to four nurses and ambulance coordinators to handle medical emergency calls (113), internal hospital alarms and local requests for a doctor. Even though the intensity and work loads are very different between the LV and AMK centres, the technical artefacts that are used are basically similar in both types of centre.

Using a comparative case approach, the use of technology was studied through interviews with nurses, doctors and administrative personnel and by observations of the work in six LV and three AMK centres.

There are three main findings in this thesis. First, the operation of LV centres in nursing homes conflicts with the general nursing home practice, and many LV centres are redefined by its users as switchboards to decrease the burden that is placed upon them.

Second, the nurses who work with requests for doctors in a similar way in the AMK centres in fact manage to solve many problems on the phone. The thesis discusses how these differences have emerged from performing the same job with the same technological tools.

Third, the handling of emergency calls at the AMK centres is accomplished through intense social and technically coordinated work. An ideal model of this kind of coordination, “the coordinated climate”, is developed from the observations in the AMK centres, and results from control room studies are applied.

The three findings are summarised in a discussion of how structures constrain and facilitate social and technological practice.

The epistemological basis of medical education has been highly contested since the turn of the twentieth century, with 'traditional', science-based curricula gradually being replaced by 'innovative' curricula, purporting to be more holistic. Both curricular types are currently employed in the United Kingdom, amid calls for both fu11her reform and a return to traditional teaching. This thesis explores the sociological meaning and consequences of debates over knowledge in medical education by examining the construction of legitimate knowledge in two English medical schools, one 'traditional' and one ' innovative'. Part I includes a literature review and theoretical discussion. Research on medical students ' experiences shows that they learn to value scientific and clinical 'competence' rather than 'caring'. Furthermore, sociologists argue that curricular reform serves symbolic purposes in medical schools but does not effect meaningful change. However, the relationship between students and medical schools is not well understood. Pierre Bourdieu's theoretical framework is proposed as a way of reconciling the analytical schism between research focusing on either student socialisation or organisational factors. Part II presents the research findings. Data were collected via six months' paiticipant observation at the two schools, semi-structured interviews with thirty-six medical students and fifteen faculty members, and analysis of institutional documents. By analysing the schools' marketing strategies, histories and relationships to external bodies, I show that medical education operates as a field in which medical knowledge is a form of symbolic capital: medical schools compete for scientific capital on the one hand, sustained by mechanisms within the higher education field, and, on the other, for clinical capital, fostered by the healthcare field. The two schools I studied were positioned unequally and oriented towards different sides of the medical education field. Faculty members participated in the dualistic competition for knowledge-based capital, largely reproducing their own institution's construction of legitimate knowledge. Drawing on their habitus, students also perpetuated the field struggle through their choice of medical school and their perceptions of legitimate knowledge. In turn, students' practices and dispositions were shaped by their school's position in the field. Ultimately, the struggle for scientific and clinic.al knowledge precluded holistic medical education: humanistic and social knowledge were marginalised in both the 'traditional' and the 'innovative' school, having little value within the field. Educational reform is thereby limited by this competition over knowledge, which is a 'game' played to gain institutional and individual power, rather than to produce good doctors.

In this thesis it is argued that the migration of ideas and personnel from Britain to colonial Australia resulted in the reproduction of two distinctive medical archetypes, namely, the soldier/saviour and the generalist (family) physician and surgeon. These have been both conceptualised as ideal type carriers or expediters of two rival forms of medical professionalism. They each emerged in the modern era as institutional products of distinctive educational processes and work practices available for doctors in 19th and 20th century Britain and Australia. While Freidson (1988) asserts one of the problems of dealing with studies of professionalism is that researchers have failed to clearly define work patterns, he could be seen as being close to Foucault (1973) whose emphasis was on the different social spaces in which practitioners worked. I show firstly that the career of the imperial army medical officer was revived in the 19th century so that in colonial contexts they could alternate between military and civilian servicing, especially as administrators and managers in public office. The soldier/saviour was also associated with the 19th century revival of Masonic and quasi-Masonic military and religious orders, consecrated by royal sovereigns and exported to Australia. In contrast, the Scottish pedagogues and other generalist doctors coming to Australia from Britain were influenced by Edinburgh University's Medical Faculty's humanist traditions and design of the modern medical curriculum producing the generalist physician and surgeon who met community needs. Within wider imperial social relations, these generalist doctors were looked upon as dissenting or counter-hegemonic. The aim of this thesis is to examine these archetypes in terms of their characteristics of rationalisation to analyse and understand their professional differences historically as well as in the contemporary period. The significance is that one does not often come across studies which specifically look at doctors within the same society in such terms. Furthermore, by locating them within wider hegemonic and counter-hegemonic social relations, links between ideas about medical professionalism and issues of human rights become evident. This follows the World Health Organization's directives to treat health or medical issues and human rights as a cross-cutting research activity. To my knowledge, no study has been undertaken in Australia of the background and impact of these different traditions.

In this thesis it is argued that the migration of ideas and personnel from Britain to colonial Australia resulted in the reproduction of two distinctive medical archetypes, namely, the soldier/saviour and the generalist (family) physician and surgeon. These have been both conceptualised as ideal type carriers or expediters of two rival forms of medical professionalism. They each emerged in the modern era as institutional products of distinctive educational processes and work practices available for doctors in 19th and 20th century Britain and Australia. While Freidson (1988) asserts one of the problems of dealing with studies of professionalism is that researchers have failed to clearly define work patterns, he could be seen as being close to Foucault (1973) whose emphasis was on the different social spaces in which practitioners worked. I show firstly that the career of the imperial army medical officer was revived in the 19th century so that in colonial contexts they could alternate between military and civilian servicing, especially as administrators and managers in public office. The soldier/saviour was also associated with the 19th century revival of Masonic and quasi-Masonic military and religious orders, consecrated by royal sovereigns and exported to Australia. In contrast, the Scottish pedagogues and other generalist doctors coming to Australia from Britain were influenced by Edinburgh University's Medical Faculty's humanist traditions and design of the modern medical curriculum producing the generalist physician and surgeon who met community needs. Within wider imperial social relations, these generalist doctors were looked upon as dissenting or counter-hegemonic. The aim of this thesis is to examine these archetypes in terms of their characteristics of rationalisation to analyse and understand their professional differences historically as well as in the contemporary period. The significance is that one does not often come across studies which specifically look at doctors within the same society in such terms. Furthermore, by locating them within wider hegemonic and counter-hegemonic social relations, links between ideas about medical professionalism and issues of human rights become evident. This follows the World Health Organization's directives to treat health or medical issues and human rights as a cross-cutting research activity. To my knowledge, no study has been undertaken in Australia of the background and impact of these different traditions.

Developed on the boundary between medicine and sociology, this thesis develops a critique of the perspectives of these disciplines through analysis of a study of women's perspectives on hormone replacement therapy. Women's perspectives are explored through a postal questionnaire survey and a study using individual interviews and focus groups. The survey results provide a measure of women’s attitudes towards, and knowledge of, hormone replacement therapy. The individual interviews detail the way women move towards a decision about the therapy and identifies common themes, particularly women's fears and what influences their fears. The focus groups explore contrasting themes including women's control and choice in decisions about therapy, contrary themes in women’s attitudes and the different ways of thinking used by the women. The results of the studies are assessed for their implications for clinical general practice. The thesis also takes a sociological perspective on women and HRT and on the research process, in particular exploring two themes. Firstly, the interaction between the social context, the research subject and the research process. This includes the social factors influencing the development of the research and choice of research methods, and the influence of the research methods on the results obtained. The second theme is the perspectives and levels of analysis used by the main disciplines contributing to the thesis; biomedicine, biostatistics, general practice and sociology. The thesis explores how the different perspectives and levels of analysis influence research and how they are used to manage the social context. These explorations are used to suggest future directions for research on hormone replacement therapy and for general practice.

Background During a period of continuing changes in society and increasing availability of medical information, publication of patients’ views on experiences of health and illness have gained greater prominence. By contrast, studies of medical perspectives have tended to concentrate on reported discontent and implications for workforce planning while leaving broader insights and concerns under-investigated. Since the applied skills of highly trained and publicly funded clinicians are vital for safe and effective delivery of the nation’s health care, it seemed important to explore new ways to consider components of medical professionalism and to set these in current NHS contexts. Rationale and fieldwork Focussing attention on the individual perspectives of NHS doctors in order to hear and understand their experiences of work was central to development of this thesis. An interpretive epistemological approach to biographical narratives as told by a group of 12 doctors drawing on 25 years of NHS experience included use of Situational Analysis Mapping to support detailed analysis of their richly informative, first-hand accounts. As knowledgeable and reflective informants with stories from diverse clinical specialties and differing personal viewpoints, their narratives produced a range of views and observations shaped by their lived experiences as clinicians. Poetic representation of sociologically-informative narrative extracts provided an effective vehicle for engaging mixed audiences and has evoked emotionally resonant reactions from doctors. Findings Strong connections between individuals’ core principles and enacted responses were evident; doctors identified preferred working practices which they believed supportive of delivery of high quality health care. Key aspects of professionalism, including professional autonomy, self-regulation and application of clinical knowledge, were challenged by progressive introduction of new working processes and regulatory mechanisms. Increased recording of clinical and administrative data for performance monitoring and achievement of targets produced reactive strategies in individuals and teams while challenging their sense of professional position or developed medical identity. Poorly performing colleagues and difficult team interactions caused much disruption while blurred ethical boundaries exposed contestable decision-making and demonstrated the limited effectiveness of external regulatory monitoring. Conclusions This research indicates that contemporary NHS doctors may experience conflict between what is expected in managed medical practice and their interpretation of best professional performance. Better understanding of these fundamental relationships could constructively contribute to reconsideration of contemporary medical professionalism and assist with progressive workforce preparation for an effective future NHS.

In this thesis it is argued that the migration of ideas and personnel from Britain to colonial Australia resulted in the reproduction of two distinctive medical archetypes, namely, the soldier/saviour and the generalist (family) physician and surgeon. These have been both conceptualised as” ideal type” carriers or expediters of two rival forms of medical professionalism. They each emerged in the ‘modern’ era as institutional products of distinctive educational processes and work practices available for doctors in 19th and 20th century Britain and Australia. While Freidson (1988) asserts one of the problems of dealing with studies of professionalism is that researchers have failed to clearly define work patterns, he could be seen as being close to Foucault (1973) whose emphasis was on the different social spaces in which practitioners worked. I show firstly that the career of the ‘imperial’ army medical officer was revived in the 19th century so that in colonial contexts they could alternate between military and civilian servicing, especially as administrators and managers in public office. The soldier/saviour was also associated with the 19th century revival of Masonic and quasi-Masonic military and religious orders, consecrated by royal sovereigns and exported to Australia. In contrast, the Scottish pedagogues and other generalist doctors coming to Australia from Britain were influenced by Edinburgh University’s Medical Faculty’s humanist traditions and design of the “modern” medical curriculum producing the generalist physician and surgeon who met community needs. Within wider imperial social relations, these generalist doctors were looked upon as ‘dissenting’ or counter-hegemonic. The aim of this thesis is to examine these archetypes in terms of their characteristics of rationalisation to analyse and understand their professional differences historically as well as in the contemporary period. The significance is that one does not often come across studies which specifically look at doctors within the same society in such terms. Furthermore, by locating them within wider hegemonic and counter-hegemonic social relations, links between ideas about medical professionalism and issues of human rights become evident. This follows the World Health Organization’s directives to treat health or medical issues and human rights as a cross-cutting research activity. To my knowledge, no study has been undertaken in Australia of the background and impact of these different traditions.

This project explores the dynamics of medical innovation using the development of deep brain stimulation therapy in paediatric neurology as a case study. Ethnographic research was conducted with a multidisciplinary clinical team developing a novel clinical service that uses deep brain stimulation (DBS) to treat children and young people with movement disorders. Interviews and observations were carried out to identify key challenges encountered by team members, and to explore the way in which team members attempt to manage these challenges in day-to-day clinical practice. Four key challenges were identified: coordinating multidisciplinary teamwork, identifying suitable candidates for deep brain stimulation; managing the expectations of patients and families; and measuring clinical outcomes. By exploring the strategies used by team members to overcome these challenges, this thesis develops the Complex Model of Medical Innovation which challenges prevalent, linear ‘bench-to-bedside’ understandings of innovation. While scientific ‘discovery’ is one source of medical innovation, new therapies in medicine also emerge from technology transfer (the transfer of technology from one sector into another) and clinicians’ learning-in-practice (the ability of clinician to learn ‘on the spot’). Importantly, this thesis demonstrates that technology transfer, learning-in-practice, and medical innovation in general are shaped by various socio-political trends. The activities of the multidisciplinary team and their novel DBS service, for example, have been shaped by the evidence based medicine movement, commercial interests, and a movement that promotes multidisciplinary approaches to paediatric service provision. A consequence of these influences is that the team subjects their patients to a broad clinical gaze. Adopting the Complex Model of Medical Innovation has important consequences: First, it draws attention to the innovative activities of clinicians, activities that may be worth disseminating in other contexts. Second, it highlights the role of existing social and material factors in shaping the development of new clinical services. The social impact of new technologies will be influenced by these contextual factors and cannot be attributed to the technology alone.

Currently, a mismatch exists between the race and ethnicity of the U.S. physician workforce and the patients it serves. The federal government, the Association of American Medical Colleges (AAMC), individual medical schools and other organizations are addressing this mismatch in part by focusing on increasing the numbers of racial/ethnic minorities who matriculate into medical schools. However, it is unclear how minority students navigate the medical school admissions process. This study used a grounded theory approach to explore the medical school admissions experiences of a sample of Black/African-American and Hispanic/Latino students. The study developed and proposed elements of an emerging conceptual model for understanding the reasons why participants applied to medical school, as well as the facilitators and barriers they encountered in the admissions process. Participants were purposively selected Black/African-American and Hispanic/Latino medical students who attended 25 U.S. allopathic medical schools nationwide. Phase 1 included 29 telephone interviews with individual participants and four in-person interviews in groups of two students each. Phase 2 consisted of feedback sessions with five of the original participants to verify four emergent themes: 1) reasons for applying, 2) participants' perceptions of navigating the admissions process, 3) the role and sources of information, guidance, and support, and 4) other forces affecting how participants navigated the admissions process. Reasons for applying to medical school included: perceived fit; prior experience or knowledge; encouragement and role models; desire to help others; perceived benefits; and interest in science. In addition to information, guidance, and support, other forces influenced how participants navigated the admissions process. These forces included: information, guidance and support; finances; preparation; extra programs; extracurricular activities; and attitude. Study findings connect to theories of student college choice and academic capital formation. Findings have implications for research and practice related to advising; reviewing admissions practices; outreach and recruitment; extra programs; mentoring; improved provision of information; and data collection.

This thesis is about medical doctors with immigrant backgrounds who work in Sweden. Based on 15 qualitative interviews with medical doctors with immigrant backgrounds, this thesis explores the medical doctors’ feeling of professional belonging and boundary work. This thesis focuses mainly on the doctors’ experiences of being part of the Swedish medical profession while, at the same time, being regarded as ‘different’ from their Swedish medical counterparts. It starts off with the idea that medical doctors with immigrant backgrounds may have, or could be regarded as having, contradictory social positions. By virtue of being part of the Swedish medical profession, they belong to one of the most privileged groups in Swedish society. However, due to their immigrant background these doctors do not necessarily occupy a privileged position either within their profession or in society in general. This thesis shows that doctors with immigrant backgrounds feel that they are not perceived as full-fledged doctors, which seem related to how they are somewhat ‘othered'. The results show that these doctors cope with being seen as different from doctor with non-immigrant backgrounds, by using the notion of ‘migranthood’ as a resource in negotiations in everyday work life but they also do what they can to overcome the boundaries of ‘Swedishness’. Belonging should therefore be seen as having a formal and an informal side, as getting a Swedish license does not automatically mean that you feel belonging to, in this case, the Swedish medical profession. This seems to put doctors with immigrant backgrounds in a somewhat outsider within position, which seems having to do with boundaries between who is included in the ‘us’ and in the ‘them’. Lastly, these findings indicate that sociologists need to expand the understanding of professional groups to also include boundary work within these groups. In order to do so, this thesis argues that sociological theory on professional groups could be combined with sociological theory about social positions as that is one way to understand the outsider-within position that these doctors (and presumably other skilled migrants) have to cope with.

Addiction treatments have a very low rate of successful recovery in the U.S., consequently, treatment recidivism and substance abuse death are imminent. The purpose of this paper was to determine the relationship between marginalization and what type of treatment an individual received. This paper used a binary logistic regression to determine whether being a marginalized increases likelihood of receiving the lesser form of addiction treatment. The independent variable was split into 11 marginalization/privilege variables. The hypothesis for this paper were split into three models: 1) marginalization predicts an increase in an individuals likelihood of receiving Narcotic Anonymous treatment, 2) marginalization predicts an increase in the likelihood of receiving treatment in a Methadone maintenance facility, and 3) privilege predicts an increase in an individuals likelihood of receiving the inpatient treatment type. There are two variables that have a significant impact across all three models. Legality of income and status of felony record both impact the likelihood of receiving a certain treatment type. Thus, marginalization in the form of an illegal income or a felony record does increase an individual’s likelihood of receiving both Narcotics Anonymous as well as Methadone treatment types. Inversely, privilege increases an individual’s likelihood of receiving the inpatient treatment type. In conclusion, having illegal income and/or a felony record increases the likelihood of receiving the lesser treatment forms, while, having legal funds and no felony record increases the likelihood of receiving the better treatment option. This means that while privileged folks get treatment for their addictions marginalized folks remain a permanent addict in 12-step or die from a drug related illness.

This sociological study of medical school culture employed a critical framework for analysis of ideological reproduction and social control. A literature review provided a social-historical context for the empirical findings that focused on student-faculty discourse at one college of medicine during the third-year Family and Community Medicine clerkship. Data collection consisted of audio recording and observation in both classroom and clinical settings. A depth hermeneutical analysis was used to answer three research questions. For question 1, "What is the macro medical social context within which ideologies are being reproduced and received in medical education?" a literature review on recent trends in health care delivery and medical education elucidated the social-historical conditions in which ideological and social control constructs are embedded today. The principal finding was that the U.S. health system is embroiled in a revolution, characterized by the frequently contradictory ideologies of medical advocacy and business allocation. For question 2, "What are the principal ideological and social control messages being reproduced in medical education?" a discursive analysis of faculty-student dialogue was structured around eight thematic elements. Findings revealed that medical education does not prepare students to think critically about social and environmental issues that cause 85% of illness in our society, with faculty dominance often acting as a major deterrent. The principal messages being reproduced extended from a therapeutic ideology that promotes the physician's definition/control of patient problems. Also found was a deeply conflictual relationship between managed and medical care. For question 3, "How does the meaning mobilized by these ideological messages in medical education serve to establish and sustain relations of domination and social control?" an interpretive process clarified how ideology and social control sustain relations of power that systematically confound and effectively eliminate social justice in health care. Because the right to define the patient's problem gives the physician extraordinary power, the drive to reach a differential diagnosis is extremely strong, and gaining diagnostic expertise is medical education's consuming focus. As a result, students leave medical school prepared for their professional social control role, while uncritically accepting the inequitable and illness-causing social, economic, and political ideologies of our time.

The hospital setting provides an environment for patients to receive medical care, for medical professionals to provide treatment, and for medical students and residents to learn the practice of medicine through supervised patient encounters. Education provided at the point of care allows students and residents to apply knowledge and develop clinical skills needed for medical practice. The hospital environment is also a confluence of learning and work, where applied learning takes place in an integrated and simultaneous manner with work duties. This setting, referred to as the clinical learning environment (CLE), is a focus for educators, scholars, administrators, regulators and accrediting agencies to understand, measure and improve it. While several instruments have been developed to measure the CLE, they suffer from great variation in subscales and content. The purpose of this study is to deconstruct the CLE, apply theories from related fields, and frame those theories in the context of the hospital setting to develop a conceptual framework for the CLE. A systematic review of the literature and thematic synthesis of existing research about the CLE provided evidence to inform and test a learning environment framework in the clinical setting. Data from qualitative CLE assessments, the ACGME Clinical Learning Environment Review (CLER) Pathways to Excellence, and existing CLE measurement instruments informed these results. Findings showed that a CLE framework consists of three mediating factors: learning, people, and change. As the clinical setting is a unique environment for learning, the people dimension (as a community of practice) was found to be the most influential on learning outcomes for students. The dimension of change was found to be most influential from the perspective of improving organizational or work outcomes, including patient care, clinical quality and patient safety. Findings from this study provide researchers and scholars with a framework to for developing measures of clinical learning environment effectiveness, and informing practitioners of CLE components and relationships that impact both learning and organizational outcomes.

South Africa is facing a severe shortage of medical doctors and has a government that is sceptical of reliance of foreign skills known as skilled immigration. The government and the national Department of Health (DoH) have implemented a variety of intervention measures in order to alleviate the negative impact of this shortage caused by medical skills shortage in the sector. However, the DoH's reluctance to recruit foreign medical doctors, and particularly its prohibition on the recruitment of doctors from South Africa's neighbouring countries, undermines the government's effort to increase the number of doctors in the health system. Skilled immigration, the importation of scarce skills from outside the country, made little progress with the enactment of the Immigration Act 13 of 2002. The priority of South Africa's immigration policy is still focused on controlling skilled immigration, as is underlined by its protectionism and restrictiveness. The Department of Home Affairs' (DHA) immigration policy and its counterproductive approach to attracting skilled foreign labour has drawn criticism from a wide range of people including academics, politicians and businesspeople. The DHA itself has in its white papers of 1999 and of 2017 admitted that its inflexible approach to immigration has resulted in the country's failure to attract skilled foreign workers. In this study, I use archived parliamentary meeting minutes and parliamentary documents as the primary data source to understand the deliberations of stakeholders on skilled immigration which resulted in the Immigration Act 13 of 2002. The Act had a direct effect on the DoH's approach to the recruitment of foreign medical doctors. More specifically, this dissertation aims to explore how stakeholders who were involved in the drafting process of the Immigration Act 13 of 2002 deliberated on the existing cultural and structural conditions that resulted in the Immigration Bill which preceded the Act. By exploring the changes in the immigration policy, the dissertation aims to understand the impact of the immigration policy and institutional xenophobia on the recruitment of foreign doctors. Margaret Archer's (1995) morphogenetic/morphostatic cycle is used to understand the development of South Africa's immigration policy from 2000 to 2006 as this was the period in which the discussion of the Immigration Bill started. I argue that institutional xenophobia which is manifested in South Africans' antagonism towards foreign nationals, the deeply-entrenched employment equity policy that promotes national workers, the weakened state of the civil society, and the consolidated power of the government in decision-making all contributed to the DoH's decision to restrict the recruitment of foreign medical doctors. In the absence of government's support, it is unlikely that there will be a conducive environment to put in place a skilled immigration policy that can harness skilled foreigners' skills and facilitate skilled foreigners' entry. This dissertation suggests that the government critically review its immigration policy which is deepening South Africa's skills gap in the medical field. This dissertation further recommends the government to consider the option of allowing foreign doctors to work in the private sector. This would not only increase the overall number of doctors in the health sector, it would also dispel the public's concern that the employment of foreign doctors would cost a hefty amount at the expense of the public.

Thesis advisor: Eve Spangler
This study seeks to better understand the "public face" of human gene therapy through an examination of coverage of the technology in mainstream U.S. newspapers, news magazines, and online news sites from 1989 to 2011. By conducting a qualitative content analysis that employs a constant comparative method and uses the computer-assisted qualitative data analysis software HyperRESEARCH, prevailing images and metaphors about human gene therapy are identified. These images and metaphors are analyzed through the lens of the sociology of technology, with particular attention given to technological determinism, geneticization, and the sociology of expectations. Further, their connection to issues of self and identity, embodiment, and illness meanings is explored. Four main types of images and metaphors emerge from this analysis: essentialist, fatalistic, expectant, and conflictive. While these types present an array of diverse (and sometimes conflicting) characterizations of human gene therapy, they all contribute to a positive, hopeful public face of the technology, despite its limited successes and sometimes tragic failures over the past three decades. The study considers the broader implications of these findings and addresses the role sociologists could play in helping the public to navigate the media discourse surrounding human gene therapy and other emerging medical technologies
Thesis (PhD) — Boston College, 2012
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Sociology

Users play a key role in many training strategies, yet some organizations often fail to understand the users’ perception after a simulation training implementation, their attitude about acceptance or rejection of and integration of emerging simulation technology in medical training (Gaba, 2007, and Topol, 2012). Several factors are considered to contribute to the acceptance level of simulation training by the users, including cost, the existing training and certification policies, technical issue, realism of training, values of it, concerns about it, and its effect on the patients outcome, and medical errors (Clever, 2011and Dawson, 2006).An often overlooked factor in the success of a simulation training merger is the impact on the users and medical profession (Dickemen, 2007). This qualitative phenomenological research study explored the lived experiences of a purposeful sampling of medicals simulation training users in the decision and none decision making roles, who had been involved in simulation training at least for one year. The study obtained their perceptions, their lived experiences, feelings associated with the experience, and interactions. And then how those feelings, perception, opinions, attitudes, and interactions evolved. Data suggested that the presence of feelings attached to experience, preconceived views, existing training policies, affect the level of effectiveness, users’ view of its outlook, impact on the decisions, and the medical profession. In addition the users’ perception, beliefs, and feelings all affect the interpersonal dynamics, interactions, communications, of simulation training users during adoption of simulation technology and its implementation. Understanding the medical simulation training phenomena through the understanding of users’ perspective can redefine how they communicate, interact, share, learn in simulated environment , and from one another that help with the subsequent additions and modifications to the existing simulation training strategies.

Homoeopathic practitioners in the United Kingdom can be divided into two groups,those with medical qualifications and those without, professional homoeopaths. This study examines these two groups to discover how they practise homoeopathy and why. Also examined are any tensions that may exist, both between the two groups and within the groups. Collecting qualitative and quantitative data using questionnaires and interviews, a randomly selected sample of homoeopaths was studied. All subjects were members of either the Faculty of Homoeopathy or the Society of Homoeopaths. The study starts by examining the development of homoeopathy over its almost 200 year history. Following this section data regarding the practice of homoeopathy and the opinions of homoeopaths on this practice are discussed. The homoeopath's opinions regarding their opposite numbers are also discussed, that is professional homoeopath's opinions of medically qualified homoeopaths and vice versa. The data highlighted a number of tensions that exist between medically qualified homoeopaths and professional homoeopaths. Medically qualified homoeopaths questioned the wisdom of allowing non-medically qualified people to practice homoeopathy and the professional homoeopaths questioned the validity of the homoeopathic methods used by medically qualified homoeopaths. Tensions within professional homoeopathy were also identified between pro and anti professionalisation and registration subgroups. Another tension identified was between those professional homoeopaths who claim to use the original, 'classical' formulation of homoeopathy and those using a more eclectic therapeutic regime with changes to the original method incorporated into their practices. Finally, the utility of the concept of heresy when describing both medically qualified homoeopaths and professional homoeopaths in the United Kingdom was addressed. Although the labelling of heretics is properly reserved for those members of the orthodoxy, not for researchers, a small number of homoeopaths were identified as holding potentially heretical ideas. On the whole the medically qualified homoeopaths and the majority of professional homoeopaths could not be regarded as heretics or dissenters in any way. In the light of the tensions that were identified, and the policies being promoted by the professional bodies, the conclusion examines the possible future of homoeopathy in the United Kingdom in the first years of the new millennium. A thoroughly modernist medicine in a possibly postmodern era.

Thesis (DPhil)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: In this thesis, an ‘alignment approach’ to the quality assurance of medical curricula is developed and practically illustrated in the evaluation of a section of a new curriculum in undergraduate medical education and training instituted at the Faculty of Health Sciences of the University of Stellenbosch in 1999. The background of curriculum innovation at this institution during the 1990s is described, and the literature on the concepts of quality assurance is explored in higher education in general and in medical education and training in particular. The current focus on socially responsive curriculum renewal and accountability illustrates the need for this study. The empirical part of the study was conducted in two phases. The first phase consisted of a ‘clarification evaluation’. The planning of the new curriculum introduced in 1999 was analysed retrospectively through a study of the planning documents and interviews with leaders of the planning process. The results of this clarification evaluation are presented in the form of a ‘Logic Model’. The implicit theory of the curriculum, as represented by the Logic Model, was then evaluated regarding its consistency with trends in medical education. These trends were determined through a study of the literature on the subject published during the time of the planning of the curriculum. It was found that the planning of the curriculum was in line with most of the identified trends, but that it lacked detailed information on how the basic sciences and clinical skills training were to be addressed. This compromised the evaluability of phase I of the curriculum and of the clinical rotations1 by the method use in this study. Because of this, and also considering the time frame of this evaluation, phase I of the curriculum and the late clinical rotations were excluded from the second phase of the study. The aims identified for the curriculum during the process of clarification evaluation were also aligned with the document, The Profile of the Stellenbosch Doctor 2 . This indicates that the planning process of the curriculum was in line with its intended outcome.The second phase of the study consisted of an ‘implementation evaluation’ of phases II and III of the theoretical components and of the early and middle clinical rotations of the curriculum. Data for this implementation evaluation were collected from April 2002 to June 2003. Module chairpersons3, lecturers and students were used as sources of data for the evaluation of the theoretical phases. The perceptions of these groups regarding the implementation of phases II and III of the theoretical part of the curriculum were collected by means of questionnaires designed specifically for this study. For the evaluation of the clinical rotations, the results of the standard student feedback obtained by the Faculty of Health Sciences were used as a source of data for a secondary analysis. The study guides provided for each of the theoretical modules and the clinical rotations were also used as a secondary source for the analysis of data. The data obtained were then analysed by using the framework provided by the Logic Model. Following this, a judgment of the quality of the implementation of the curriculum was made. The planned curriculum was aligned with the practised curriculum by drawing up a ‘curriculum scoreboard’. It was found that alignment was adequately achieved for six of the identified aims, while the implementation of four of the aims was not aligned to the planning according to the criteria used in this study. The study illustrates that the methods of programme evaluation can be validly applied in the evaluation of a curriculum in medical education and training. The Logic Model enables an alignment between the planned and the practised curriculum, which can be used as a measure of the quality of a curriculum in terms of ‘fitness of purpose’. 1 See Addendum A for a diagrammatic overview of the curriculum. The curriculum was structured into three theoretical phases (phases I, II and III) and three clinical rotations (early, middle and late). 2 This document was drawn up during the initial phases of the planning process of the curriculum and regarded by the Faculty as a blueprint for the intended outcomes of the curriculum. 3 A module chairperson in the context of the Faculty of Health Sciences of the University of Stellenbosch is a senior faculty member responsible for the organisation and management of the modules presented as part of the curriculum in medical education and training.
AFRIKAANSE OPSOMMING: In hierdie tesis word ʼn ‘belyningsbenadering’ tot die gehalteversekering van mediese kurrikula ontwikkel en prakties op die proef gestel deur ʼn gedeelte van die nuwe kurrikulum vir voorgraadse mediese onderrig, wat in 1999 aan die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch ingestel is, te evalueer. Die agtergrond van kurrikulumverandering in hierdie instansie gedurende die 1990’s word ondersoek, en daar word ’n oorsig gegee van die literatuur oor die konsepte van gehalteversekering wat op daardie stadium in die hoër onderwys in die algemeen en in mediese onderrig in besonder in gebruik was. Die huidige fokus op sosiaal responsiewe kurrikula en verantwoordbaarheid illustreer die noodsaaklikheid van ʼn studie van hierdie aard. Die empiriese gedeelte van die studie is in twee fases uitgevoer. Die eerste fase het bestaan uit ‘n ‘verklarende evaluasie’. Die beplanning van die 1999-kurrikulum is retrospektief geanaliseer deur die bestudering van die relevante beplanningsdokumente en deur onderhoude met leiers van die beplanningsproses te voer. Die resultate van die verklarende evaluasie is in die vorm van ʼn ‘Logika Model’ voorgestel. Die implisiete teorie van die kurrikulum, soos voorgestel in die Logika Model, is daarna geëvalueer ten opsigte van die ooreenstemming van die model met die tendense in mediese onderrig wat op daardie stadium geldig was. Hierdie tendense is nagespeur in die belangrikste literatuur oor die onderwerp wat in dieselfde tydperk as die beplanning van die 1999-kurrikulum gepubliseer is. Die bevinding was dat die beplanning van die kurrikulum in lyn is met die meerderheid geïdentifiseerde tendense, maar dat die basiese wetenskappe en opleiding in kliniese vaardighede nie in detail aangespreek is nie. Dit het die evalueerbaarheid van fase I van die kurrikulum en die kliniese rotasies4 deur die metode wat in hierdie studie gebruik is, gekompromitteer. Om hierdie rede, en met inagneming van die tydsraamwerk van hierdie evaluasie, is fase I en die laat kliniese rotasies nie in die tweede gedeelte van hierdie studie ingesluit nie. Die doelwitte van die kurrikulum wat gedurende die verklarende evaluasie geformuleer is, is ook met die dokument, Die Profiel van die Stellenbosch dokter 5, belyn. Dít het aangedui dat die beplanningsproses van die kurrikulum in lyn met die beoogde uitkoms daarvan is.Die tweede deel van die studie het bestaan uit ʼn ‘implementerings-evaluasie’ van fases II en III van die teoretiese komponente en van die vroeë en middel kliniese rotasies van die kurrikulum. Data vir die implementerings-evaluasie is vanaf April 2002 tot Junie 2003 ingesamel. Modulevoorsitters6, dosente en studente is as bronne van data vir die evaluering van die teoretiese fases gebruik. Die indrukke van hierdie groepe persone betreffende die implementering van die teoretiese fases is deur middel van vraelyste ingesamel wat spesiaal vir hierdie studie ontwerp is. Vir die evaluering van die kliniese rotasies is die resultate van die standaard studenteterugvoer wat deur die Fakulteit ingewin word, gebruik as bron vir sekondêre analise. Die studiegidse wat vir elke teoretiese module en die kliniese rotasies verskaf word, het ook as ʼn bron vir sekondêre data-analise gedien. Die data wat vir hierdie studie ingewin is, is deur middel van die raamwerk wat deur die Logika Model verskaf is, geanaliseer. Daarna is ʼn oordeel gevel oor die kwaliteit van die implementering van die kurrikulum. Die kurrikulum-soos-beplan is belyn met die uitgevoerde kurrikulum deur ’n ‘kurrikulumtelbord’ op te stel. Die bevinding was dat hierdie belyning voldoende bereik is vir ses van die geïdentifiseerde doelstellings van die kurrikulum, terwyl die uitvoering van vier van die doelstellings nie goed met die beplanning daarvan belyn was volgens die kriteria wat vir hierdie studie gebruik is nie. Hierdie studie illustreer dat die metodes van programevaluasie geldig toegepas kan word in die evaluering van ’n kurrikulum in mediese onderrig en opvoeding. Die Logika Model maak dit moontlik om die beplande kurrikulum met die uitgevoerde kurrikulum te belyn. Dit kan dan gebruik word as ’n maatstaf van die kwaliteit van ’n kurrikulum in terme van ‘geskiktheid vir doel’.4 Sien Addendum A vir ʼn diagrammatiese oorsig van die kurrikulum. Die kurrikulum is gestruktureer volgens drie teoretiese fases (fases I, II en III) en drie kliniese rotasies (vroeg, middel en laat). 5 Hierdie dokument is gedurende die vroeë fases van die beplanningsproses van die kurrikulum saamgestel en word deur die Fakulteit as ʼn bloudruk vir die beoogde uitkomste van die kurrikulum beskou.6 ’n Module-voorsitter in die konteks van die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch is ʼn senior lid van die fakulteit wat verantwoordelik is vir die organisasie en bestuur van die modules wat as deel van die kurrikulum in mediese onderrig en opleiding aangebied word.

Initiée dans les années 1960, la radiologie interventionnelle comprend les actes médicaux invasifs ayant pour but le traitement ou le diagnostic d’une pathologie réalisés sous guidage ou sous contrôle d’un moyen d’imagerie. L’enjeu de la thèse est de développer l’analyse sociohistorique de l’émergence d’une spécialité médicale – la radiologie interventionnelle – et d’en étudier les stratégies de légitimation. Trois axes d’investigation interdépendants sont plus particulièrement privilégiés. Le premier d’entre eux vise à comprendre comment est née cette pratique médicale en établissant l’archéologie des innovations dont elle résulte. Dans le deuxième, il s’agit d’analyser les stratégies de valorisation et les modes de faire-valoir de la radiologie interventionnelle. Les velléités d’autonomisation des radiologues interventionnels les ont ainsi conduits à mobiliser différents registres de légitimité (légitimité scientifique, légitimité professionnelle dans le champ médical, légitimité régulatoire). Le troisième axe permet quant à lui la prise en compte de la question de la démarcation sociale et des frontières. Étant porteuse d’une transgression de la dichotomie établie entre sphères diagnostique et thérapeutique, la radiologie interventionnelle a de fait entraîné une reconfiguration des relations entre spécialités. L’investigation s’appuie sur une méthodologie plurielle combinant entretiens semidirectifs, observations in situ (bloc opératoire, scanner, réunions de concertation pluridisciplinaire, consultations) et exploitation de données scientométriques. Une mise en perspective internationale avec la situation canadienne permet d’étudier l’impact des contextes nationaux sur la diffusion et la reconnaissance de la radiologie interventionnelle
Introduced in the 1960s, interventional radiology includes invasive medical procedures for the treatment or diagnosis of a pathology performed under the guidance or control of an imaging device. The aim of the thesis is to develop the sociohistorical analysis of the emergence of a medical specialty – interventional radiology – and to study its legitimization strategies. Three interdependent lines of inquiry are privileged in particular. The first aims to understand how this medical practice was born by establishing the archaeology of the innovations that gave rise to it. In the second, it is a question of analyzing the strategies of valorization and the ways of valuing interventional radiology. The interventional radiologists’ desire for independence has led them to mobilize different registers of legitimacy (scientific legitimacy, professional legitimacy in the medical field, regulatory legitimacy). The third line of inquiry allows for the issue of social demarcation and boundaries to be taken into account. As it is a means of transgressing the established dichotomy between the diagnostic and therapeutic spheres, interventional radiology has in fact led to a reconfiguration of the relations between specialties. The investigation is based on a methodology combining semi-directive interviews, in situ observations (operating theater, multidisciplinary consultation meetings, consultations) and the use of scientometric data. An international perspective on the Canadian situation makes it possible to study the impact of national contexts on the dissemination and recognition of interventional radiology

This dissertation explores the spatial patterns and place-based characteristics of colorectal cancer (CRC) late stage incidence and CRC-specific mortality in Miami-Dade County. Because CRC is the second leading cause of death among all cancers and is almost 90 percent preventable through medical screenings, investigations of CRC disparities across groups and communities are extremely relevant in the fight against cancer. This paper analyzes the geographic distribution of CRC cases in Miami-Dade County between two periods, 1988-1992 and 1998-2002 to: a) identify significant "hot spots" or clusters of disease; b) investigate associations of CRC patterns with neighborhood level characteristics such as socio-economic status, race/ethnicity, and poverty; and c) explore the policy implications of the spatial trends identified for the disease, with particular reference to the Welfare Reform Act of 1996. This dissertation analyzes data from the Florida Cancer Data Registry and tract level U.S. Census data, to identify the spatial distribution of CRC and study its relation to place-based variables using Geographic Information Systems (GIS) and spatial statistical modeling. Identifying spatial clusters of disease can assist in targeting public health interventions and improving social service delivery, particularly for uninsured populations. Identifying communities facing greater obstacles to screenings and quality medical care through the use of spatial analysis is an effort to mitigate these barriers while simultaneously providing empirically based evidence linking neighborhood-level social and economic conditions to health disparities.

After hundreds of years of use the medical properties of Marijuana have been marginalized in our society. Qualitative interview data was collected from medical marijuana patients and knowledgeable producers and activists in Michigan about their perceptions and observations on the medical use of marijuana. Patients consistently reported using marijuana to substitute or wean off prescription drugs. All patients and producers who were taking opiate narcotics claimed they reduced overall drug use, especially opiates, by using medical marijuana. Patients and caregivers also claimed medical marijuana was preferred over opiates, eased withdrawal from opiates, and in some cases was perceived as more effective at relieving pain. Other issues explored included the operation of the Michigan Medical Marijuana Act, the formation and operation of medical marijuana centers in the face of countervailing State and federal, opposition, and the varieties and effects of different strains of medical marijuana.

Keywords: Medical Marijuana, State and Federal Marijuana Laws, Michigan Marijuana, Controlled Substances, Drugs, Qualitative Interviews

This thesis examines women's treatment seeking behaviour for their own illnesses and that of children underfive in Kamwokya . The focus is on the extent to which women's access to money and time use patterns affect treatment seeking. It has been argued that women's treatment seeking behaviour is influenced more by their time use than their access to and availability of money.The findings obtained through the use of case histories and in-depth interviews indicate that though women in Kamwokya have access to their own money, mainly through participation in income generating activities (business), illness management for children under-five and even more for the women themselves, remains problematic. Women are overworked and manage fragile businesses that require their personal attention and presence. Hence, treatment seeking is done in a manner that will ensure minimal disruption of businesses. Consequently children's health, and even more so, that of women , is compromised for the sake of other family needs.This thesis demonstrates that illness management is not context free, and that no one factor can explain the whole process ; it both affects and is affected by other things happening in the family. Due to the multiple roles women have to fulfil, "time use "is found to be the organising and central factor in illness management for both women and children in Kamwokya, whether from rich or poor households.The thesis concludes by suggesting that policy makers, health care providers and professionals ought to take into account the daily routines of family life in their plans and programmes. Strengthening of private sector health providers, health education programmes and increased awareness raising of male responsibilities towards their families are recommended as a way of improving the health of women and children in Uganda.

Wrongful convictions have garnered recent increased attention in Canada, but specific concern with the use of medical expert evidence in criminal trials is especially timely. With the recent Inquiry into Pediatric Forensic Pathology in Ontario, it has become clear that flawed medical expert evidence can have devastating effects on individuals and criminal trials. The theoretical framework of social constructionism was used in a cross-case pattern analysis to provide a foundation for examining the problematic expert testimony of Dr. Charles Smith in eight cases of unexplained child death. The findings suggest that Dr. Smith's expert evidence was not adequately evaluated at the gate of admissibility, and may have been evaluated by internalized judgments rather than direct assessments of that evidence. The results indicate a combination of contributing factors of Dr. Smith's flawed expert evidence and the subsequent miscarriages of justice, as Dr. Smith's flaws were overlooked and his testimony accepted uncritically.

In 2008, the election of President Barack Obama brought health care to the forefront of national discussions and led to the passage of the Patient Protection and Affordable Care Act (ACA). The legislation changed the rules of health care delivery in the United States, but the ACA did not do one fundamental thing: It did not end the need for many of the nation's most needy patients to seek free medical care from groups such as Remote Area Medical (RAM). A mobile clinic, RAM brings together volunteer dentists, physicians, nurses, and other professionals as well as support staff for multi-day clinic events to provide free, on-site care to anyone presenting for treatment without qualification questions. This thesis looks at the ongoing need for RAM in central Appalachia after the passage of the ACA due to a continued lack of comprehensive health care coverage for all Americans.

Se hizo una revisión de la literatura publicada sobre el origen de la sociología médica y su campo de acción. Para ello, se analizaron diversas publicaciones y se resumieron los aspectos más relevantes. A pesar de que la enfermedad siempre ha estado ligada a aspectos socioculturales, recién a mediados del siglo XX, la medicina reconoce la importancia de la sociología en la explicación de temas relacionados a la salud, especialmente para explicar los determinantes sociales de la salud. En la actualidad, los sociólogos trabajan de manera multidisciplinaria con médicos para investigar y analizar cuestiones concernientes a la salud de las personas, para mejorar el bienestar y la calidad de vida de la población. En este sentido, el aporte de la sociología no solo ha enriquecido la comprensión de algunas enfermedades, sino también diferentes aspectos en el quehacer de la medicina.
Revisión por pares
Revisón por pares

The thesis consists of three self-contained articles that empirically investigate socio-economic differences in, and interrelationships amongst, science knowledge, biomedical self-efficacy, and participation in medical decision-making. Chapter 2 investigates age-related bias in the science knowledge questions in the Wellcome Trust Monitor Survey Waves I and II. It also examines what evidence there is for three dimensions of knowledge. Chapter 3 studies the influence of Internet use and paying attention to medical stories online in reducing science knowledge and biomedical self-efficacy gaps between low and high educational groups. Wave II of the Wellcome Trust Monitor Surveys is employed in this chapter. Chapter 4 scrutinises the influence of various socio-economic factors, biomedical self-efficacy, and trust in physicians and other medical practitioners on public willingness and confidence to take part in the medical decision-making process. Chapter 4 uses Wave III of the Wellcome Trust Monitor Survey. Chapter 2 finds evidence for age-related bias in the science knowledge battery of questions; no evidence of a misinformed group of respondents was found; a group who consistently said they didn’t know instead of providing an answer that was wrong was found; a sensitivity analysis showed that using the summed score approach leads to the same substantive conclusions as a model taking into account age-related non-invariance. Chapter 3 finds evidence of education-based knowledge and efficacy gaps. It also finds some evidence that the Internet can help reduce that democratic deficit in information. Chapter 4 finds evidence that people are generally confident to participate. Those who are more self-efficacious are also more confident to participate in medical decisions. The opposite held true for those who place high trust in doctors. Women were found to be more confident than men.

This thesis examines how a more powerful and a less powerful profession --allopathic medicine and podiatry -- are linked in a series of networks through patient referrals and practice activities. The importance of professional networks is that they link different professions such as podiatry and allopathic medicine in ways which direct attention away from ranking the power of fields or viewing them as endlessly in conflict over occupational turf (traditional research questions) to questions of the actual and regularized relationships diverse professions have with one another. This thesis analyzes professional training and activity variables related to the emergence of networks and another set of conditions that results once occupational networks become established. Data were obtained from a mailed questionnaire survey of podiatrists who practice in the Chicago metropolitan area (N-168). Analysis consists of comparisons between podiatrists who are in networks with physicians and those who are not: and between DPM's who are in heterophilous (general referral) versus homophilous (surgical) networks with MD's. T -tests are the major form of statistical analysis used in this thesis. The findings of this thesis support the conclusion that the educational training and podiatric practice mandates (e.g., hospital staff appointment) are important determinants of the formation of networks with MD's. Friendship and social interaction patterns between DPM's and MD's and attitudes of DPM's toward podiatry were found to be highly related to network relationships between podiatrists and medical doctors. Profiles of podiatrists' professional activities and the extensiveness of their referral communication with MD's also were found to be related to the type of network podiatrists are in with medical doctors. Overall, results of this thesis clearly show that networks do link podiatrists and physicians and that such networks have important consequences for the professional activities and orientations of DPM's.

This is an exploratory study of women’s childbearing decisions and outcomes in non-medically indicated cesarean section childbirths (CS). Focusing on the structure-agency dichotomy, the research is guided by Anthony Giddens’ theory of structuration used in the context of the medicalization framework in order to analyze elements of personal choice and medical jurisdiction in childbearing methods. Quantitative analysis of secondary data and a thematic content analysis of Internet forums are conducted in order to analyze women’s perceptions of autonomy and constraint in their childbearing decisions and outcomes. The findings suggest that the polarization between second- and third wave feminist critiques on medical intervention in childbirth, and between structure and agency, impede our understanding of the complex phenomenon. Applying structuration theory to the medicalization framework helps to work through this polarization, further lending support to third-way feminism.